Risk Factors of Non-Communicable Diseases Among Populations in Banat Area, Wad Medani City, Gezira State, Sudan 2013

The burden of non-communicable diseases is on the rise in middle and low income countries on top of the existing infectious diseases. In Sudan, non-communicable diseases account for a total of (44%) of all deaths. Moreover, the distribution of the specific risk factors are not systematically identified in the Gezira state, hampering the designing of appropriate preventive and control strategies. The objective of this study was to describe the distribution and prevalence of behavioral risk factors for non-communicable diseases. This cross sectional community based study was conducted in Banat area, Wad-Medani, Gezira State, Sudan, in May 2013. Data were collected using structured questionnaire. A total of 380 individuals over 40 years of age were selected for the study by simple random sampling technique. Data were analyzed using SPSS for Windows version (16.0). The distribution of the various categories of risk factors was identified. Among the behavioral risk factors, the prevalence of smoking for males and females were (25.8%) and (2.1%) respectively, alcohol consumption prevalence (1.1%), consumption of fruits and vegetables below adequate level (52.1.0%), low level physical activity (68.4%). All the risk factors were found more prevalent in males than females. This study showed Cigarette /tobacco use and physical inactivity were associated with personal history of NCDs and were found highly statistically significant (p-value <0.005). The study found, half (50%) of the study participants had family history of NCDs. Forty –two percent(42%) of study population had documented personal history of one of the NCDs, of which a combination of (DM+HTN) accounted for (12.6%) of cases followed by diabetes mellitus alone (11.1%). In conclusion, the magnitude of risk factors for noncommunicable diseases is considerably high in the study population. Appropriate preventive measure should be designed to prevent and control these risk factor

Training a fit-for-purpose rural health workforce for low- and middle-income countries (LMICs): how do drivers and enablers of rural practice intention differ between learners from LMICs and high income countries?

Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points—entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway

Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study

Background: Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions. Methods: The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet’s Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent. Results: Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds

Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study

Background: Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions. Methods: The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet’s Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent. Results: Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds

Does a socially-accountable curriculum transform health professional students into competent, work-ready graduates? A cross-sectional study of three medical schools across three countries

Background: Socially-accountable health professional education (SAHPE) is committed to achieving health equity through training health-workers to meet local health needs and serve disadvantaged populations. This research assesses the biomedical and socially-accountable competencies and work-readiness of first year graduates from socially-accountable medical schools in Australia, the United States and Sudan. Method: A self-administered survey to hospital and community health facility staff closely associated with the training and/ or supervision of first year medical graduates from three SAHPE medical schools. Main outcome measure: Likert scale ratings of key competencies of SAHPE graduates (as a group) employed as first-year doctors, compared to first year doctors from other medical schools in that country (as a group). Findings: Supervisors rated medical graduates from the 3 SAHPE schools highly for socially-accountable competencies (‘communication skills’, ‘teamwork’, ‘professionalism’, ‘work-readiness’, ‘commitment to practise in rural communities’, ‘commitment to practise with underserved ethnic and cultural populations’), as well as ‘overall performance’ and ‘overall clinical skills’. Interpretation: These findings suggest SAHPE medical graduates are well regarded by their immediate hospital supervisors, and SAHPE can produce a medical workforce as competent as from more traditional medical schools, but with greater commitment to health equity, working with underserved populations, and addressing local health needs